ICD-10 First of Many Health IT Mandates

With 2013 barely started and the "fiscal cliff" debate barely finished, many doctors are worried about a "cliff" of a different sort that they will be facing a year from now -- one dealing with information technology (IT).

Physicians have three upcoming IT deadlines in 2014: one for implementing "meaningful use" requirements for electronic health records (EHRs); another for implementing e-prescribing; and a third deadline for implementing ICD-10, the new diagnostic coding system with tens of thousands more codes than its predecessor, ICD-9.

System Seen as Too Complex

After the Department of Health and Human Services (HHS) proposed a 1-year delay in implementation of ICD-10 -- short for International Classification of Diseases, version 10 -- doctors now must meet an Oct. 1, 2014 deadline for implementing the system or face not getting Medicare or Medicaid reimbursements.

Physician groups had cried for years to forgo ICD-10 use, claiming the system was too complex, too hard to use, and that most providers didn't understand it. Although they weren't able to get the system scrapped, they did manage to delay its mandated use.

For nearly every provider group, ICD-10 expands the number of diagnostic codes from a few to a few dozen. Experts joke that a burn isn't simply coded a burn anymore, but a "burn incurred from a fire while surfing."

Joseph Schneider, MD, vice president of clinical informatics at Baylor Health Care System in Dallas, points to a simple reason for why doctors have been dragging their feet for years on installing ICD-10 into their work flow.

"The average physician gets zero benefit from converting to ICD-10," he said. "No benefit at all." That's a contrast to EHRs and e-prescribing, both of which come with financial incentives provided by the federal government.

With ICD-10, the benefit comes for health insurers and statisticians who can learn more about the procedures being ordered for patients.

Looking for Alternatives

Most medical societies have supported one of a few tracks as an alternative to ICD-10.

One is waiting for ICD-11, which is supposed to be much more friendly in working with EHRs, and will be coming in a few years. It's the system other countries are eyeing a switch to now.

"Why in the world would we put something in that everybody else is about to retire?" Schneider said. "Why don't we find the better solution, which does exist, and work toward putting that in place so that we get ahead of everybody else?"

The American College of Physicians (ACP) supports a system called SNOMED CT -- Systematized Nomenclature of Medicine -- Clinical Terms -- which translates codes for all ICDs.

Shari Erickson, the ACP's vice president of government and regulatory affairs, said SNOMED CT captures information more in a way that physicians think, whereas ICD-10 isn't as intuitive.

But whether they like it or not, medical groups are gearing up for ICD-1o's use starting in October 2014.

"There has been a significant amount of effort made by physicians to make this transition," Erickson told MedPage Today in an interview. "If you were to delay indefinitely, they would lose out." Meanwhile, the American Medical Association, American Academy of Family Physicians, and others wrote HHS earlier this month asking for a further delay.

Finding Ways to Cope

Juliet Santos, senior director at HIMSS, a Chicago-based nonprofit that works with all sectors of the healthcare industry on IT issues, said her organization recommends breaking the massive number of ICD-10 codes into digestible bites offices can chew.

"Obviously, they're not going to learn 168,000 codes," Santos said. "They only learn maybe 40 or 50 of those codes because that's what they use for their practice."

Many physicians already document to a level of detail needed for ICD-10 coding, Santos added, so offices just need to learn a corresponding new code.

Erickson suggested training programs for physicians and their staff while speaking with coding vendors to ensure they're getting ready to handle a shift to ICD-10.

"Really, at this point our focus has been on getting our members ready," Erickson said.

Switching to all those systems will be "quite a challenge," especially for smaller, paperless practices, said Erickson. "It's this mishmash of all these different requirements as they try to transition."

Having so many IT projects come online at once will cause massive headaches for physicians, Schneider told MedPage Today. He equated it to learning Russian, astrophysics, and writing with your off hand all at once.

"You can't have everything at once, and to try to do everything at once is unrealistic and fraught with danger," Schneider said. "There's a certain amount of change that you can make in a period of time and do it well."

Physicians who are wondering why so many federally mandated health IT programs are coming online at once need only look in the mirror for an explanation, Santos noted.

"They didn't use to be in close succession," she said. "The small provider groups really did it to themselves because they kept delaying it and delaying it and now they're all lumped into one big year."

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